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Lung Biopsy

What is a CT guided biopsy of the lung?

There are many individuals who are found to have a mass on a chest x ray or on a CT scan. Some lung nodules are benign but some may be malignant. The identity of the mass can only be determined after a biopsy. In the old days, the only way to biopsy a mass in the lung was surgery- which is a major undertaking. Today, the Ct scan can identity the location of the mass and a biopsy can easily be performed with a needle. The test is usually done in a radiology department and the procedure is done by a radiologist trained in invasive procedures. CT guided biopsy of the lung is not only cheaper and safer than surgery, but is a much more convenient procedure.

Who needs a CT guided lung biopsy?

Individuals with the following conditions are best candidates for a Ct guided lung biopsy:

those with a mass discovered on a chest x ray or Ct scan

those who have an unknown lung mass and are too sick to undergo surgery

those who are heavy smokers and have a lung mass

those who work in the mining industry and have a lung mass

those who have been working with asbestosis

those individuals who have had previous lung surgery and now have a new mass on chest x ray/ct scan

those individuals with a cancer elsewhere the body and now present with a mass on a chest x ray

those individuals who have thickening of their chest wall lining (pleura)

Preparations

Before the procedure, your own specialist or the radiology specialist will go through the procedure with you and will be happy to answer any questions which you may have about the procedure or the reason for undertaking the procedure. He/she will then ask you to sign a document (consent form) stating that you understand the nature and purpose of the procedure and that you are happy to carry on with it.

How is the procedure done?

You will be asked to change into a hospital gown and lie flat on the table. The area to be biopsied with be determined by the CT scan. At this point, the chest area will be cleaned with n antiseptic solution and sterile drapes will be placed. You will have a local anesthetic injection at the site of the procedure to make the area numb. When the area is numb, the radiologist will pass a small needle between the ribs. The place where the needle goes may be either in front or behind the chest. This needle will pass into the lung guided by a CT scan and a small piece of tissue will be sampled. Two or three biopsies may be required to obtain an adequate specimen. During the procedure, it is necessary to be still for a few seconds until the biopsy is obtained. The procedure is not painful and takes about 30-45 minutes to accomplish.

Who is at high risk for the procedure?

CT guided of the lung is a safe procedure, however, some patients may be at risk for complications. These include patients with:

emphysema

COPD

Chronic bronchitis

Asthma

Lung fibrosis

What are complications of lung biopsy?

The possible complications after a needle biopsy of lung include:

Hemoptysis (coughing up blood)

pneumothorax (collapsed lung)

bleeding in chest cavity

pain

require admission for shortness of breath

In the majority of individuals, the procedure is done without any complications. In all cases, a chest x ray is done after the procedure and the patient is observed for a few hours. If there is no complication, the individual is discharged home.

What happens after the procedure?

The CT guided lung biopsy generally takes anywhere from 30-60 minutes. Once the procedure is done, the individual is always observed for at least 2-4 hours. Only in some minor cases is the individual admitted if there is suspicion of a possible problem. Most individuals are asked to rest for the next 24 hrs. Following this, all patients can resume their normal activities.

Because CT guided lung biopsy can present with a delayed complication, it is recommended that one go home and rest for the night. Once you have been discharged, if you feel significantly more short of breath than usual anytime in the first 24 hours after the procedure, you are advised to attend the emergency department of your nearest hospital.

When can I resume normal activities?

There is always a small dressing placed at the biopsy site. The dressing may be removed the following day and one can shower. There are never any stitches placed. Your bandage may be removed one day following the procedure, and you may bathe or shower as normal. You should not exert yourself physically (such as heavy lifting, extensive stair climbing, sports, etc.) or travel by airplane the night of and for one full day following your biopsy. On the second day, if you feel up to it, you may return to your normal activities.

Should I be aware of any problems?

Yes. Rarely, the lung can collapse after a lung biopsy. This is generally evident right after the procedure but in some cases may present late (within the next 12-24 hours). Signs to watch out for include onset of shortness of breath, a fast rate, profuse sweating, chest pain or pale coloring of the skin. If you experience any one of these symptoms, you must present yourself to the nearest emergency room.

What happens if I have a collapsed lung?

If a collapsed lung is suspected, a chest x ray will be done to make a diagnosis. The treatment depends on the degree of lung collapse. If the collapse is less than 5%, then you may be observed either in the hospital or at home and get daily chest x rays for several days to ensure it is not getting worse. If the lung collapse is larger than 10% or if you have any symptoms, a small drainage catheter will be inserted in your chest to suck out all the air and reexpand the lung. You will be admitted for several days.

Do I need admission after a CT guided lung biopsy?

Maybe. If the CT guided biopsy of the lung is done in the morning and the chest x ray done after the procedure is fine, you will be observed for 2-4 hours. If all is fine, you will be allowed to go home.

If the CT guided lung biopsy is done in the afternoon, it is safe to be admitted overnight and be discharged in the morning the following day.

When can I get the results?

In most cases the tissue biopsied is sent to the pathologist. The tissue analysis usually takes anywhere from 2-5 days and the final results are available from the physicians in about 7-10 days.

What are the advantages vs disadvantages of CT guided lung biopsy?

Advantages

CT guided biopsy is less invasive then surgery

It can help prevent unnecessary surgery

There is only need for local anesthesia

Is a useful tool in sick patients who may not be candidates for surgery

Can access sites which may be difficult with surgery

Is usually an out patient procedure

Is much cheaper than surgery

Disadvantages

With any technique where needles are inserted in the body, risks can be expected and these include:

Bleeding

Pain

Hemoptysis

Infection

What are the limitations of CT guided lung Biopsy?

In some cases where the lesion is very small, the needle may not be able to obtain a decent sample size. In such cases, either a second attempt may be done or surgery.

Needle biopsy is not cost effective when the lesions are less than 1-2 mm.

For those individual who have blood disorders, CT guided biopsy may be very risky.

For those individuals with congestive heart failure, emphysema, COPD, CT needle biopsy is not recommended.

Alternatives to biopsy may include continued follow-up with imaging and surgical removal of the abnormality.